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  • Disaster Medicine and Public Health Preparedness, Volume 8, Issue 1
  • February 2014, pp. 20-29

Confined Space Medicine and the Medical Management of Complex Rescues: A Case Series

  • Bruno Petinaux (a1), Anthony G. Macintyre (a1) and Joseph A. Barbera (a2)
  • DOI:
  • Published online: 14 February 2014

A variety of hazards can precipitate the full or partial collapse of occupied structures. The rescue of entrapped survivors in these situations can be complex, require a multidisciplinary approach, and last for many hours.


The modern discipline of Urban Search and Rescue, which includes an active medical component, has evolved to address such situations. This case series spans several decades of experience and highlights the medical principles in the response to collapsed structure incidents.


Recurring concepts of confined space medicine include rescuer safety, inter-disciplinary coordination, patient protection, medical resuscitation in austere environments, and technical extrications.


Strategies have been developed to address the varied challenges in the medical response to collapsed structure incidents. (Disaster Med Public Health Preparedness. 2014;0:1–10)

Corresponding author
Correspondence and reprint requests to Bruno Petinaux, MD, Department of Emergency Medicine, The George Washington University Medical Faculty Associates, Ste 450, 2120 L St, NW, Washington, DC 20037 (e-mail
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3.JA Barbera , A Macintyre . Urban search and rescue. Emerg Med Clin North Am. 1996;14:399-412.

4.WT Chiu , J Arnold , YT Shih , etal. Survey of international urban search-and-rescue teams following the Ji Ji earthquake. Disasters. 2002;26:85-94.

5.JA Barbera , M Lozano . Urban search and rescue medical teams: FEMA task force system. Prehosp Disaster Med. 1993;8:349-355.

6.EB Hsu , M Ma , FY Lin , MJ Van Rooyen , FM Burkle Jr. Emergency medical assistance team response following Taiwan Chi-Chi earthquake. Prehosp Disaster Med. 2002;17:17-22.

7.S Mirhashemi , A Ghanjal , HA Mohebbi , Y Moharamzad . The 2003 Bam earthquake: overview of first aid and transport of patients. Prehosp Disaster Med. 2007;22:513-516.

9.XD Bai , XH Liu . Retrospective analysis: the earthquake-injured patients in Barakott of Pakistan. Chin J Traumatol. 2009;12:122-124.

11.G Lin , H Lavon , R Gelfond , etal. Hard times call for creative solutions: medical improvisations at the Israel Defense Forces Field Hospital in Haiti. Am J Disaster Med. 2010;5:188-192.

12.P Halpren , B Rosen , S Carasso , etal. Intensive care in a field hospital in an urban disaster area: lessons from the August 1999 earthquake in Turkey. Crit Care Med. 2003;31:1410-1414.

13.C Yang , HY Wang , HJ Zhong , etal. The epidemiological analyses of trauma patients in Chongqing teaching hospitals following the Wenchuan earthquake. Injury. 2009;40:488-492.

14.L Zhang , H Li , JR Carlton , etal. The injury profile after the 2008 earthquakes in China. Injury. 2009;40:84-86.

15.JM Mulvey , SU Awan , AA Qadri , MA Magsood . Profile of injuries arising from the 2005 Kashmir earthquake: the first 72 h. Injury. 2008;39:554-560.

20. The final sacrifice of a gallant nurse: Oklahoma City bombing. May 8, 1995; vol 43:17.

22.OS Better . The Crush syndrome (1940-1990). Nephron. 1990;55:97-103.

23.Q He , F Wang , G Li , etal. Crush syndrome and acute kidney injury in the Wenchuan earthquake. J Trauma. 2011;70:1213-1218.

24.JD Moede . Medical aspects of urban heavy rescue. Prehosp Disaster Med. 1991;6:341-348.

25.M Michaelson , U Taitelman , S Bursztein . Management of crush syndrome. Resuscitation. 1984;12:141-146.

26.MM Sagheb , M Sharifian , J Roozbeh , M Moini , K Gholami , H Sadeghi . Effect of fluid therapy on prevention of acute renal failure in Bam earthquake crush patients. Ren Fail. 2008;30:831-835.

27.R Vanholder , M De Smet , E Hoste , etal. Earthquakes and crush syndrome casualties: lessons learned from the Kashmir disaster. Kidney Int. 2007;71:17-23.

28.W Li , J Qian , X Liu , etal. Management of severe crush injury in a front-line tent ICU after 2008 Wenchuan earthquake in China: an experience with 32 cases. Crit Care. 2009;13:R178.

29.Y Oda , M Shindoh , H Yukioka , S Nishi , M Fujimori , A Asada . Crush syndrome sustained in the 1995 Kobe, Japan, earthquake; treatment and outcome. Ann Emerg Med. 1997;30:507-512.

30.OS Better . History of the crush syndrome: from the earthquakes of Messina, Sicily 1909 to Spitak, Armenia 1988. Am J Nephrol. 1997;17:392-394.

32.D Gonzalez . Crush syndrome. Crit Care. 2005;33:S34-S41.

33.J Oda , H Tanaka , T Yoshioka , etal. Analysis of 372 patients with Crush syndrome caused by the Hanshin-Awaji earthquake. J Trauma. 1997;42:470-475.

34.J Smith . Greaves I: Crush injury and crush syndrome: a review. J Trauma. 2003;54:S226-S230.

35.DJ Malinoski , MS Slater , RJ Mullins . Crush injury and rhabdomyolysis. Crit Care Clin. 2004;20:171-192.

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Disaster Medicine and Public Health Preparedness
  • ISSN: 1935-7893
  • EISSN: 1938-744X
  • URL: /core/journals/disaster-medicine-and-public-health-preparedness
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